Aromaterapia con conciencia ecológica. espacioprimavera@gmail.
com
Aromatherapy for Pain Relief
by Bob and Rhiannon Harris
Introduction
Managing pain remains one of the biggest challenges in med-
ical care today, with chronic disabling pain in particular af-
fecting millions of people around the world. Our experience
has shown us that in many cases aromatherapy can offer a
significant way forward as either a complementary or alterna-
tive form of pain relief for a large number of people. There
are several possible reasons why this may be so and this ar-
ticle aims to examine possible ways by which essential oils
and the global aromatherapy experience may help the person
in pain.
Pain as a Unique Experience
To begin with, we need to remind ourselves that pain is a
multidimensional experience. Until relatively recently, pain
was defined largely from a physiological/sensory viewpoint.
One of the biggest contributions of Melzack and Wall in
1965[1] was to widen the understanding of pain to include
somatic, cognitive and affective aspects that are all integral
and essential to the pain experience. This acknowledgment
that psychological and emotional factors also play a key role
in how pain is perceived, appraised and effectively treated is a
clear step forward.
Pain can be difficult to assess and classify. This is because the
experience of pain is unique, subjective and highly personal. It
also has complex psychological, social and spiritual aspects.
As aromatherapists, we have to rely on the client to express
their experience of the pain and to respect their impressions.
One of the most important steps a therapist can make in their
initial assessment of the person in pain is to take a detailed
case history. Within this context, there may be questions per-
tinent to the person's pain experience. Typical questions con-
cerning the pain experience itself are included in Figure 1.
Figure 1. Typical pain questions
1. Where is the pain?
2. Is it localised or generalised?
3. When did the pain begin?
4. Is there a past history?
5. Is it related to work, injury or activity?
6. Are there aggravating or precipitating factors?
7. Is there a pattern to the pain?
8. Does it interfere with normal activities?
9. Is it constant, intermittent or episodic?
10. What is the pain like?
11. What is its severity?
12. Is there associated stiffness, swelling or inflammation?
13. What helps to ease it?
14. Are there associated neurological symptoms?
The words the person in pain uses to describe their pain can
reveal their experiences from a sensory, cognitive and affec-
tive perspective. Words such as 'sickening', 'blinding',
'frightful', 'miserable' and 'unbearable' are commonly used de-
scriptors. These words have significant affective or cognitive
weighting. Words such as 'sharp', 'burning', 'shooting',
'pounding' and 'throbbing' have a more somatic emphasis.
Thus effective listening skills are essential for the therapist in
order to hear truly what the person is saying about himself or
herself.
As a holistic approach is the most effective model for working
with pain management, let us take a moment to explore fur-
ther aspects of a person's unique experience of pain.
Página 1 de 4
The Person in Pain
A general observation of the person in pain is that they are
often 'trapped in the moment'. As time goes by and pain con-
tinues, the concept of a future without pain is harder to
grasp and to focus on. Pain becomes the focus of their atten-
tion. Many people feel that they are controlled by pain; it
dominates every aspect of their life.
There are many variables with regard to the perception of
pain by an individual. However, the most common factor is
that of anxiety, in particular the fear of pain or the fear of
more pain. This has an impact not only on the experience of
pain but also on the person's coping strategy that is highly
individual and may be influenced by cultural and social fac-
tors as well as past experiences. A vicious cycle (Figure 2) may
quickly develop whereupon fear leads to anxiety, which in
turn increases attention and focus on the pain.
If pain persists, then instead of fear and anxiety, a sense of
failure, frustration, anger and depression may be experienced.
Depression is a feature of most chronic painful conditions.
Often in this stage, the person is likely to adopt passive cop-
ing mechanisms or avoidance behaviour which in the short
term can give some relief but in the long term can perpetuate
the problem.
There are intrinsic relationships between injury, pain and
stress (physical or psychological). Pain always initiates the
stress response/alarm state. Any type of stress has a profound
impact on the immune system. Chronic stress is particularly
disabling. It can actually perpetuate and contribute to ongo-
ing chronic pain via peripheral and central nervous system
mechanisms.
Sleep deprivation is another common feature of the person in
pain. This is partly due to the fact that pain creates an alarm
state and thus affects arousal and wakefulness. A lack of
sleep potentiates pain.
The sensation of pain also leads to postural, behavioural and
social changes. If the person locks into a 'pain posture' and
maintains this for any prolonged period of time, biodynamic
stress is placed on the musculoskeletal system, leading to
compensatory changes that may include endocrine and nerv-
ous system changes and lead to further imbalance. Further-
more, the 'sick role' that the person may adopt may include
further behavioural and social changes that perpetuate the
problem. If a person's experience has taught them that a par-
ticular action (e.g. a massage or a cup of tea) brings relief,
their expectation is likely to affect the end result positively.
One of the most common assumptions by the person in pain
is that activity/exercise will exacerbate or aggravate the condi-
tion. In many cases this is a false assumption, at least in the
case of chronic pain or when avoidance of activity and
movement is prolonged. Periods of inactivity can lead to a vi-
cious cycle (Figure 3) whereby pain creates fear and leads to
avoidance behaviour that in fact increases disability and pain.
 Aromaterapia con conciencia ecológica. espacioprimavera@gmail.com
Thus avoidance of activities that may create pain may help to * reduce inflammation (Figure 4);
reduce anxiety but in fact precipitates the pain itself! * give a local anaesthetic effect (Figure 5);
* create a counterirritant stimulus (Figure 6);
* establish analgesia (Figure 7);
* reduce spasm (Figure 8);
* create a sensation of cooling (essential oils such as pepper-
mint and eucalyptus);
* create a sensation of warmth and increase local blood flow
(rubefacient essential oils).

Figure 6. Counter-irritant essential oils

Laurus nobilis bay laurel
Rosmarinus officinalis rosemary
If we consider the above points as situations we frequently
encounter with persons in pain, it becomes obvious that es- Piper nigrum black pepper
sential oils may be able to give positive assistance in a num- Thymus vulgaris ct thymol* thyme thymol chemo-
ber of ways that can directly or indirectly affect the pain ex- type
perience. oregano
Origanum vulgare*
How Aromatherapy Can Help clove bud
Syzygium aromaticum*
Generally speaking, aromatherapy has a positive role to play
Cinnamomum camphora camphor
with regard to pain management, both in reducing existing
pain and preventing/reducing anticipated pain. If we take the Gaultheria procumbens* wintergreen
various aspects of pain (somatic, affective and cognitive) we Betula lenta* sweet birch
can summarize as follows. peppermint
Mentha piperita
Working with the Somatic Aspects of the Pain Ex- eucalyptus
Eucalyptus globulus
perience
Melaleuca cajuputi cajeput
Aromatherapy can work in real, direct and practical ways to
help reduce pain perception. Figures 4 to 8 list typical essen- * w/professional advice only
tial oils used to exert the physical effects mentioned below.

Figure 4. Anti-inflammatory essential oils Figure 7. Analgesic essential oils

Achillea millefolium yarrow Cymbopogon citratus lemongrass
Chamaemelum nobile Roman chamomile Lavandula angustifolia lavender
Matricaria chamomilla German chamomile Lavandula latifolia spike lavender
Helichrysum italicum immortelle Lavandula x intermedia lavandin
Cedrus deodara Himalayan cedarwood Laurus nobilis bay laurel
Cymbopogon martinii palmarosa Mentha piperitat peppermint

Mentha arvensis cornmint Eucalyptus globulus eucalyptus

Elettaria cardamomum cardamom
Lavandula angustifolia Lavender
Pinus sylvestris Scots pine
Zingiber officinale Ginger
Coriandrum sativum coriander seed
Pinus sylvestris Scots pine
Cedrus deodara Himalayan cedar
Melissa officinalis melissa
The reader is referred to the bibliography at the end of the ar-
ticle for examples of research pertaining to these physical ef- Melaleuca cajuputi cajeput
fects. Essential oils can be used to: Gaultheria procumbens* wintergreen
Betula lenta* sweet birch
Figure 5. Local anaesthetic essential oils * with professional advice only

Syzygium aromaticum* clove bud

Ocimum gratissimum
Cinnamomum verum fol.*
Laurus nobilis
Lavandula angustifolia
Mentha piperita
Mentha arvensis
* with professional advice only
tree basil
cinnamon leaf In order to exert the aforementioned effects, the essential oils
need to be applied to the skin, preferably in the locality or
bay laurel
close to the site of the pain. Hot or cold compresses, oint-
lavender ments and creams or gels containing essential oils are the
peppermint most common forms of application, with the dose and fre-
cornmint quency of application dependent on the type and severity of
the painful condition.

Página 2 de 4
 Aromaterapia con conciencia ecológica. espacioprimavera@gmail.com
If combined with massage or other physical therapy, there are
additional benefits:
* Restoration or improvement in mobility;
* Short-term relief by joint mobilization;
* Increase in endorphin production;
* Activation of descending pain control systems;
* Stimulation of healing in peripheral joints;
* Sensory distraction as a form of pain relief.
Obviously the usual contraindications to massage apply in
painful conditions, such as over broken bone, severe inflam-
mation or infection.
Figure 8. Antispasmodic essential oils
Lavandula angustifolia lavender
Ocimum basilicum* basil methyl chavi-
col and linalool
chemotypes
petitgrain
Citrus aurantium
clary sage
Salvia sclarea
lemon scented
Eucalyptus citriodora
eucalyptus
Origanum majorana
sweet marjoram
Chamaemelum nobile
Roman chamomile
Artemisia dracunculus*
tarragon
Elettaria cardamomum
cardamom
* with professional advice only
Working with the Affective and Cognitive Aspects
of the Pain Experience
It is in this sphere where a holistic aromatherapy treatment
can be used to its fullest potential. As the affective and cogni-
tive aspects of the pain experience are just as important as
the physical/somatic aspects, aromatherapy goes far beyond
the physical to give sound and lasting benefits. Here the se-
lection of essential oils is more open to interpretation, as each
client has individual needs and preferences and the therapist
has their own experiences of how essential oils work on the
mind and emotions. For example, essential oils and the over-
all treatment approach can be selected for:
* inducing relaxation to override abnormal prolonged stress;
* improving disrupted sleep patterns;
* increasing motivation;
* improving mood states;
* restoring confidence;
* engaging social skills;
* providing emotional and cognitive support and counselling;
* using non-judgemental listening skills;
* encouraging a sense of control over pain;
* using a whole-person focus rather than a pain focus;
* acknowledging anxiety and fear;
* encouraging active and positive coping strategies;
* encouraging greater mobility.
Much of the above-mentioned effects are achieved through
inhalation of essential oils during treatment coupled with a
more general holistic approach. The therapist-client relation-
ship is fundamental to supporting the person in pain. Once
the client has achieved a sense of control over their pain in
conjunction with the use of essential oils, it is often the case
that merely the aroma of the selected blend of essential oils is
Página 3 de 4
sufficient to instigate a cascade of responses that include re-
laxation, positive affect and improved confidence. Helping the
person to live with chronic pain and encouraging them to use
positive, active coping strategies are perhaps the greatest re-
wards of aromatherapy.
To further illustrate how aromatherapy can help, consider the
following case history.
Case History - Jane - Severe Headache
Jane is a 32-year-old personal assistant who works in the city
of London. She has come for aromatherapy treatments at the
suggestion of her doctor who has been investigating her one-
year history of tension-type headaches. These occur at least
once per week, usually in the evenings after work and can last
all night, disrupting sleep and leaving her tired and stressed
the following day with feelings of being unable to cope. She
dislikes taking prescription medication but does so reluctantly
when the pain is severe. She describes the pain as "blinding,
pounding and unbearable" and associated with nausea. Her
other health history is unremarkable.
On questioning, she reveals that the severity of her headaches
has increased in parallel with increased workload, office
changes and stress at work. Her working hours are long and
her diet and fluid intake are erratic. She takes no regular exer-
cise, and her social life revolves around drinking with col-
leagues after working hours.
Treatment Approach
Jane's aromatherapy treatment plan was twofold. Firstly,
twice-weekly evening massage sessions were arranged. These
lasted one hour and were focused on her upper body (head,
neck, shoulders, back, arms and hands) in an attempt to re-
duce the muscle tension in these areas that are likely to be
contributing to her headaches. The advantage of this ap-
proach is that the selection of essential oils can include ones
for her stress and anxiety as well as muscular relaxation as the
massage is also exerting psychophysiological effects. Thus the
oils were selected for their antispasmodic, analgesic, calming
and uplifting actions (see Figure 9). As Jane was involved in
the oil selection process, the overall blend was highly perso-
nalized and once blended had a pleasing fragrance. The ses-
sions were planned to leave her deeply relaxed and the same
blend of essential oils was deliberately used with each subse-
quent treatment to establish a conditioned response, helping
Jane to link the blend with a feeling of relaxation, even when
massage was not used. Jane was then encouraged to use this
same blend of oils at home and at work whenever she felt
stressed.
Figure 9. Blend 1 - giving a 2% concentration
of essential oils
Citrus aurantium ssp bitter orange petit- 0.1ml
aurantium fol. grain
Chamaemelum nobile Roman chamomile 0.1ml
Origanum majorana sweet marjoram 0.2ml
Lavandula angustifolia lavender 0.3ml
Cedrus deodara Himalayan cedar- 0.3ml
wood
49ml
Simmondsia chinensis jojoba oil
The second approach was to help Jane directly when head-
aches did occur (see Figure 10). This blend was predominantly
 Aromaterapia con conciencia ecológica. espacioprimavera@gmail.com
created for its physical action in reducing pain[2] and given to
Jane for use at home. Jane was advised to apply a small
amount of the blend directly to the forehead, neck and pres-
sure points just below the skull. The concentration of the
formula was deliberately raised in order to exert the desired
therapeutic effect. The use of gel as opposed to carrier oil
was to enable easy penetration and not leave a greasy feel on
the skin or hair.
Figure 10. Blend 2 - giving a 15% concentration
of essential oils
Mentha x piperita Peppermint 0.5ml
Eucalyptus globulus Eucalyptus 0.25ml
Aloe vera Aloe vera gel 4.25ml
Outcome
Following a fortnight of twice-weekly massage sessions and
regular use of the blends at home, Jane was able to reduce
her appointments to weekly and then monthly massage
treatments as her frequency of headaches diminished. After
the first month of regular treatment, the blend of essential
oils was altered to suit her changing needs. When she did ex-
perience pain, the concentrated gel blend helped to reduce
its severity quickly to a manageable level, leaving her clear
headed and relaxed and without the usual accompanying
nausea. The benefits she experienced were not solely con-
fined to her headaches; she found she also had more energy,
her quality of sleep improved and her anxiety levels reduced.
As she improved, she became more motivated to make life-
style changes. These included:
* altering her office layout, especially with relation to her
computer chair and computer screen;
* taking regular short breaks to get fresh air;
* making healthy packed lunches and snacks;
* consciously drinking more water during the day;
* using her leisure time more constructively;
* developing assertiveness and delegation skills.
Conclusion
From the above it can be seen that a holistic aromatherapy
approach holds much potential for offering deep and lasting
pain relief. It goes without saying that the responsibility of
the aromatherapist to work always within their sphere of
competence. When working with the person in pain, in many
cases the person is under the simultaneous care of their doc-
tor or other health-care practitioner (osteopath, chiropractor,
etc). Close liaison between practitioners is essential.
References
1. Wall P D and Melzack R. Textbook of Pain. 4th ed. Churchill
Livingstone Press. London. 1999.
2. Gobel H et al. Essential plant oils and headache mechan-
isms. Phytomed. 2(2): 93-102. 1995.
Bibliography
Afifi NA et al. Some pharmacological activities of essential oils
of certain umbelliferous fruits. Vet Med J Giza. 42(3): 85-92.
YEAR?
Buckle J. Use of aromatherapy as a complementary treatment
for chronic pain. Alt Therapies. 5(5): 42-51. 1999.
Chandra D and Gupta SS. Anti-inflammatory and antiarthritic
activity of volatile oil of Curcuma longa (Haldi). Indian J Med
Res. 60(1): 138-42. 1972.
Página 4 de 4
El Tahir KEH. Exploration of some pharmacological activities
of cardamom seed (Elettaria cardamomum) volatile oil. Saudi
Pharmaceut J. 5(2-3): 96-102. 1997.
Galeotti N et al. Local anaesthetic activity of (+)- and (-) -
menthol. Planta Med. 67: 174-76. 2001.
Ghelardini C et al. Local anaesthetic activity of the essential oil
of Lavandula angustifolia. Planta Med. 65: 700-03. 1999.
Gobel H et al. Effect of peppermint and eucalyptus oil prepa-
rations on neurophysiological and experimental algesimetric
headache parameters. Cephalagia. 14: 228-34. 1994.
Harris B and Lewis R. Pain management: a hands-on ap-
proach. Parts 1 and 2. IJACM. 12(8) and 12(9). 1994.
Hong C-Z et al. Effects of a topically applied counterirritant
(Eucalyptamint) on cutaneous blood flow and on skin and
muscle temperatures. A placebo-controlled study. Am J Phys
Med Rehabil. 70: 29-33. 1991.
Krall B et al. Efficacy and tolerance of Mentha arvensis aethe-
roleum. Program abstracts. 24th Symposium Essent Oils.
1993.
Krishnamoorty G et al. Anti-inflammatory activity of the es-
sential oil of Cymbopogon martinii. Indian Journal of Pharma-
ceutical Sciences. pp114-16. 1998.
Lorenzetti BB et al. Myrcene mimics the peripheral analgesic
activity of lemongrass tea. J Ethnopharmacol. 34(1): 43-48.
1991.
Santos FA and Rao VSN. Anti-inflammatory and antinocicep-
tive effects of 1,8-cineole a terpenoid oxide present in many
plant oils. Phytotherapy Research. 14: 240-44. 2000.
Schafer K et al. Effect of menthol on cold receptor activity. J
Gen Physiol. 88: 757-76. 1986.
Seth G et al. Effect of essential oil of Cymbopogon citratus
Stapf on the central nervous system. Indian J Exper Biol.
14(3): 370-71. 1976.
Sharma J et al. Suppressive effects of eugenol and ginger oil
on arthritic rats. Pharmacology. 49: 314-18. 1994.
Viana GSB et al. Antinociceptive effect of the essential oil
from Cymbopogon citratus in mice. J Ethnopharmacol. 70:
323-27. 2000.
Von Frolich E. A review of clinical, pharmacological and bac-
teriological research into Oleum spicae. Wein Med Wo-
chenschr. 15: 345-50. 1968.
Wall P. Pain - The Science of Suffering. Phoenix Press. London.
1999.
Bob and Rhiannon Harris, as Essential Oil Resource Consul-
tants, are experienced educators in the field of essential oils
and aromatherapy. Based in Provence, France, they conduct
classes worldwide as well as hosting clinical aromatherapy
seminars and popular 'Aromatic Adventures' tours in the
mountains of Provence. Bob is the editor of the International
Journal of Aromatherapy and Director of Education for the
College of Botanical Medicine.
Más información en
espacioprimavera@gmail.com